Michael  M  Tucker    MD
Contract Details
Hughston Clinic--Dothan
Facility name
Provider ID
P000001768
NPI
1841232691
Tax ID
581155460
Effective Date
4/15/2010
Last Updated
12/2/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_140
Location Details
Address
348 Healthwest Drive
Dothan, AL 36303
United States
County
Houston
Phone
3346995747 (Phone)
Billing Details
Address
P.O. Box 848249
Boston, MA 02284
Billing Phone
7063246661
Specialty Type
Surgery, Orthopedic
Map
Address